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Taking the next steps

Traditionally, patients admitted to hospital would settle in for
a stay of at least a few days, but the latest research suggests
that, for older patients in particular, the shorter the time
they're in hospital, the better it is for their mental health and
physical recovery. All the indications are that once patients have
been assessed and had any necessary treatment, home is definitely
the best place for them to be.

At County Durham and Darlington NHS Foundation Trust, which
includes University Hospital of North Durham, Darlington Memorial
& Bishop Auckland Hospitals, a new initiative, #NextStepHome,
aims to change the way patients and their families think about
being admitted to hospital. Launched in November, it's already
showing positive results for patients.

Consultant physician, Dr Paul Peter, said, "We know that
patients don't want to be in hospital any longer than
necessary. For older people in particular the familiarity of
home makes a huge difference to how they feel in themselves.
They can eat the food the like, when they want it, follow familiar
routines - even enjoy the comfort of a favourite chair.
Being in hospital can also feel overwhelming - everything is new.
So, initially, when a patient comes to us, we ask ourselves whether
admission is really necessary - can the patient receive the care
they need from our community teams, at home.

"We've also introduced Consultant Connect, a telephone service
for GPs, enabling them to speak directly to our on-call consultants
for advice and guidance on urgent patient issues. In many
cases, this means the GP can give the patient the care they need,
or request tests on an outpatient basis, avoiding admission to
hospital. At the moment, the service is specifically for
patients suspected of having an acute medicine problem or a heart,
respiratory, gastroenterology or diabetes issue. GPs are already
telling us they're finding it very helpful and it means patients
are getting the care they need, quickly and in the most appropriate
place.

"When patients do need to be admitted we make sure they are
assessed as soon as possible, including getting blood tests and
results, booking scans and any other investigations needed to help
us make a diagnosis. From there, we make a plan with the
objective of getting any necessary treatment in place quickly, then
regularly assessing the patient's condition so that once they've
made the improvements we're looking for, getting them home with
packages of care, prescriptions and anything else they need,
already in place. We talk to patients at every stage, keeping them
updated. It requires commitment from everyone to make it work
but we have great teams who are focused and work well together.

"One of our main aims it to help patients return to, at
the very least, the level of independence they had before their
admission to hospital. All the evidence suggests this is more
likely the shorter the admission. At home, the activities of
normal daily living help keep us active much more effectively than
you might imagine. But all that stops when you're in hospital
and muscle strength is lost very quickly.

"We encourage patients to wear their day clothes rather than
pyjamas and comfortable shoes rather than slippers. Lots of
evidence suggests patients feel much better in themselves when up
and dressed and they're more likely to walk around, with help if
needed.

"#NextStepHome is also helping make sure that we have beds
available for new patients requiring admission"

Sharon Morgan, associate director of nursing for community
services, comments, "Older, frailer patients, and those with
long-term conditions, tell us that they want to stay at home as
long as possible and return home as early as possible following an
admission. As a healthcare system we're working in partnership to
make this happen. We appreciate that some patients and their
families will worry about whether services in the community are
robust enough to provide the care and support needed and we want to
reassure them we have a menu of services available for them,
including community nurses, intermediate care and domiciliary care
which supports people to live independently.

"In addition to our community teams, we work closely with GPs,
specialist nurses, social workers and community physiotherapists,
and therapists with other specialties, to make the transition home
as safe and seamless as possible."

Jon Holmes, consultant in Emergency medicine, said, "We don't
want anyone to hesitate to come to the emergency department or ring
999 when it's an emergency but we also encourage people to consider
the alternatives which might be best for the patient -
pharmacists can often offer great advice about medication and
symptoms, and the 111 service also offers expert
guidance.

During December 2018, over 11,000 people - that's an average of
over 350 a day - used our emergency departments at Durham &
Darlington. Many needed to be there, but many others could
probably have avoided attending, allowing us to focus on those most
in need."

Charles Blackford, from Darlington, was taken to Darlington
Memorial Hospital by his niece, when he became unwell.
Charles, 82, said, "I was assessed very quickly and had both a scan
and an endoscopy, which revealed I had internal bleeding. I
was kept up to date with what was happening and it seems some
tablets I've been taking have caused the problem. I'm now on a
different medication and feel very much better - a district nurse
is coming to see me at home tomorrow which is reassuring. I
hadn't realised quite how unwell I was. I came into hospital
to get better which is exactly what's happened - and very
quickly. It's time to go home."

Ends

Published 3rd April

'Care received was fantastic and I was very well looked after
and very impressed.'